HOSPITAL CLOSINGS NOT LIMITED TO CITY

Jean Latz Griffin, Public health writerCHICAGO TRIBUNE

Susan Schofield and her brother, David Beem, had come home to the dusty farm town of White Hall, Ill., Wednesday to move their elderly mother-struggling to breathe and wracked by a gangrenous leg-from her familiar bed to another hospital 25 miles away.

''This shouldn`t have happened,'' said Schofield, of Tampico, wiping away tears as her mother was loaded into the ambulance. ''My mother is critical. She is much too sick to be moved. I can`t believe this.''

Nurses in black armbands bid Essie farewell as they wheeled her past the empty rooms. Already, 81-year-old Jule Gray had been taken home by his wife. The two senile women who had lived at White Hall for two years had gone to a nursing home.

As soon as the town`s dentist finished the last oral surgery in the small operating room, all medical care here would cease. Everything would be over but the cleanup.

''It breaks my heart,'' said Margaret Gansz, a nurse`s aide at White Hall for 18 years. ''We are a family here.''

About 260 miles northeast of White Hall in a tough Chicago neighborhood, Freddie Zaia was just as upset that his hospital-St. Anne`s in Austin-was closing.

''I got shot in a gang-bang right in front of this store nine months ago,'' Zaia said. ''I was in the hospital 22 days, most of the time in the ICU (intensive care unit). Nobody thought I`d make it.''

Zaia, who says he is ''28 or 29, somewhere in there,'' pulled up his shirt to show an inch-wide and foot-long scar from the surgery after the shooting.

''I still got a bullet in my back, so I have to go for X-rays a lot,''

On the same day last week, Tuesday, White Hall Hospital and St. Anne`s Hospital announced they were closing their doors after more than 80 years of service to their communities.

White Hall had only 7 patients among its 30 beds; St. Anne`s had only 115 patients in 437 beds. In each case, nearly 80 percent of those patients relied on Medicaid or Medicare to pay their bills.

The most-used facility in both hospitals was the emergency room. St. Anne`s saw 100 patients a day; White Hall sometimes as many as a dozen. Yet fewer than 10 percent of those patients were admitted.

St. Anne`s and White Hall represent two facets of the changing nature of health care in America-the decline of large, inner-city community hospitals and the withering of the country`s small, rural hospitals.

''Our actual need here is not that of a full-scale hospital,'' said White Hall administrator Glenn Klein. ''To try to keep this place going the way it was would be like trying to keep a dinosaur going.''

Even before the pain of loss eases, people in Austin and White Hall are trying to determine just what kinds of health care they truly need, and how to get it.

In White Hall, located midway between Springfield and St. Louis in Greene County, a 23-member community planning committee has been meeting for four weeks to decide if White Hall and its neighbor, Roodhouse, should apply to the state for funds to develop a Rural Health Clinic. And, true to its country roots, the committee on Aug. 4 voted to use the $1,032 earned at the dunk tank during the Fourth of July celebration for its expenses.

In Austin, on Chicago`s West Side, things are more complicated. Several local politicians would like the Cook County Board to take over St. Anne`s and the nine other hospitals that have closed in the past three years as satellites for Cook County Hospital. A social service agency is investigating the possibility of converting the hospital into a skilled care nursing home. There also is talk of converting many of the medical/surgical beds to an expanded psychiatric ward.

In some ways, White Hall and Austin couldn`t be more different. Most of White Hall`s 2,800 residents are elderly, retired and white. More than 80 percent of the 138,000 people who live in Austin are black or Hispanic and 43 percent are under 20 years old. A lazy two-lane highway winds its way through White Hall. CTA buses fume their way through Austin.

But on a deeper level, the level where decisions are made about health care, the two communities are remarkably similar. Both have high rates of unemployment and poverty; few people in either place have private medical insurance.

And the closing of both hospitals will have effects beyond health care. White Hall cannot afford to lose the 52 jobs that the hospital provided. The closing of St. Anne`s will add about 500 more jobs to the 7,500 already lost in Chicago in the last three years due to hospital closings.

Both hospitals were built for other times, when the economy was better, more babies were being born, and the worlds of government and medicine were far apart. But those times are gone. Of the 79 hospitals that closed in the last year in the nation, half were in rural areas and half were in the inner city.

Part of the problem is that both rural and inner-city hospitals serve poor patients. With government health care programs paying less than $1 for every $1 of health care given, hospitals with large numbers of poor patients find themselves on a downward spiral that eventually leads to financial collapse.

Some Chicago health care experts predict that the closing of St. Anne`s and other inner-city hospitals will have a domino effect: Poor patients will be sent to fewer and fewer hospitals, thus overloading their ability to stay afloat.

But others, particularly the growing numbers of people who watched health care costs skyrocket over the last 20 years and then began to take steps to bring them into line, say the demise of the White Halls and the St. Annes of the country may be just what the cost analyst-if not the doctor-has ordered.

Hospitals, they say, are trying to cover the cost of operating large, out-of-date facilities by overcharging patients.

Government and insurance companies are trying to determine the best price they can get for medical care, regardless of a hospital`s overhead cost. If one side effect is to push the least economical hospitals out of business, well, that`s letting the marketplace function as it should, they say.

''You have several hospitals around St. Anne`s that are operating at about 60 percent capacity,'' said Marilyn Plomann, executive director of the Illinois Health Care Containment Council. ''They need St. Anne`s patients. That closing may be the ticket to survival to those other hospitals.''

But in White Hall and Austin, ''those other hospitals'' may not be what people have learned to trust. Going to a different hospital often means finding new doctors or entering what is perceived as nearly alien territory-whether it is an area controlled by a different street gang in Chicago or the site of generational feuds in rural Illinois.

Asked why she would not go to Boyd Hospital in Carrollton 10 miles away, 15-year-old Ginny Allen looked appalled that anyone could seriously suggest such an idea.

''I`m an old-fashioned country girl, and my mama raised me up with Dr. Dech,'' Ginny said. Dr. Ludwig Dech has practiced in White Hall and Roodhouse for 30 years.

''He`s the only one ever cared spit about me,'' said Ginny. ''I understand him, and he understands me. He sewed up my thumb when it got caught in the lawnmower. He fixed my ankle when I sprained it running track. I don`t like the attitude over at Boyd.''